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I ate of C afbrnia—Environmental Protection Agency see IIlSf�UCti0i15 Ott �CcI[ of ^Q�j Department of Taxrc Substances Control
<br /> arm Approsd OMB No.2050-0039(Expires 9-30-99) 4 'Sacramento,`Californra
<br /> lease printtr type. Form designed for use on efite 112-pitch, vriter. - - -
<br /> , 1-'Generator's US,EP ID Nb? Manifest'Document No'. ,' 2. Page 1 Information in the shaded areas
<br /> UNIFORM HAZARDOUS ; ' is not
<br /> requrred 6y-Federal law
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<br /> Z 15. Special r alHiandlin Intrctionsand �I nolInformation
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<br /> 16..GENERATOR'S CE IFICATI : 'I hereb declare that the contents of this Onsiggnrisent are ful ly_and accurately described above by proper shipping nome'and are dasuFied packed
<br /> Vmarked,and_lobeled,and ore in all respects in_proper condition for r,transporl.by highway according to applicable international and national government regulolrans
<br /> _ 1f I am a large quantity generator,I certify'thot I hove n'progg�om in place to reduce,th`e volume and,toxiciy of waste generated to iha�egrae'I have defermrned to be aconomrcafly
<br /> practicable and Ihat I have selected the practicable ethod of treatrtmenl,'storage,or dispasol currently available to me which minimizes the preseh!and Future threat to,human health
<br /> and the environment;OR,if I am a small quaniity generator,I have ma3e a good faith effort to minimize my wdsfe generalion'ond select the best waste management method that u"
<br /> 1 ac available to me and'that I tan afford. _ t r r
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<br /> Printed/Typed Nome §ignature' 'M}onth Year'.
<br /> w T17. Transporter 1 Acknowledgement of Receipt oFMaterials
<br /> j M nm7e _ gnalure onlh Day Y1 Yedr.-
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<br /> s>_ -8 18_ Trans iter 2 Acknowled ement of Receipt of Materials _
<br /> • O B Priya T ed No eh Da �l'ear-'
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<br /> (;,} 19. Drscrepancyfndication Space"r- t� �y��++ pp"T�r��F(,t�NJJ/{ pp(�
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<br /> 20. Facility Owner or Operator Certification of receipt of hazardous materiels covered by this manifes 9 c''Us' tad imlte 1 = a
<br /> T; -Printed/Ty ed Name Signature ->:i E r Lai;3368] onih i, Day ' -Year
<br /> D0 NOT.WRITE BELOW THIS LINE. s`
<br /> ' .•Y _ ,. .. ." 1�' _ -F fir
<br /> s , Yellow: TSDF SENDSTHIS.COPY TO GENERATOR WITHIN 30.'DAYS r
<br /> * _
<br /> .°pTSC 8022A f I/99) _ _ '(Generators who submit,hazardous waste for transport out of•sfofe
<br /> produce completed copy of this copy and send'to DTSC within 30 days I
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